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HCC Physician Handout

Medicare Severity Adjusted DRGs

Call for information on our Next CHART AUDITING Workshop on 562.430.6847.


Intense changes were made to the Inpatient Prospective Payment System for the 2008 fiscal year. These changes can be reviewed in the August 22, 2007 Federal Register. There are now 745 new DRGs replacing the old 538 DRGs.
What is different is that there are three levels for payments. These are based on severity where there is:
  • a major complication / comorbidity (MCC)
  • a complication / comorbidity (CC)
  • no complication / comorbidity (no CC)

The revisions to the complications / comorbidities will allow for easy recognition of those cases that will result in the increased utilization of hospital resources.

Present on Admission (POA)

Something to look out for in fiscal 2009 is the Present on Admission criteria that will make certain types of cases payable only if the cited conditions existed upon admission to the hospital. They are:
  • Serious Preventable Event, Object Left in Surgery
  • Serious Preventable Event, Air Embolism
  • Serious Preventable Event, Blood Incompatibility
  • Catheter-Associated UTI
  • Pressure Ulcers (Decubitus)
  • Vascular Catheter-Associated Infection
  • Mediastinitis after CABG-Surgical Site Infection
  • Hospital-Acquired Injuries; Fractures, Dislocations, Intracranial Injury, Crushing Injury, Burn, and Other Unspecified Effects of External Causes
It is imperative that your staff be prepared to identify these conditions upon admission, lest it result in lost reimbursement for the organization.

We are prepared to train your staff in the recognition of these conditions and to properly designate them on the admission record.

Do not wait until the end of the year to start this training!

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Reimbursement Specialist
7002 Moody Street, Suite 215
La Palma, California 90623
TEL 562.430.6847
FAX 562.430.6849

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